New York Assembly Bill A06484

New York 2025-2026 Regular Session

• Introduced: 3/5/25
• Refer: 3/5/25
• Report Pass: 5/20/25
• Refer: 5/20/25
• Report Pass: 6/10/25

Caption

Provides that any copayment or coinsurance amount charged by an insurer to the insured for services rendered by a physical therapist or an occupational therapist shall not be more than twenty-five percent greater than the copayment or coinsurance amount imposed for an office visit to a licensed primary care physician or osteopath for the same or a similar diagnosed condition.

Impact

If enacted, A06484 would significantly impact healthcare policy in New York by ensuring that individuals seeking therapy services are not overburdened by high out-of-pocket costs compared to primary care visits. This legislation may lead to an expected increase in patients seeking such health services, ultimately contributing to better overall health outcomes. The bill is seen as a way to align the cost of therapy with more commonly sought medical care, thus supporting patients in their rehabilitation and recovery processes without financial strain.

Summary

Bill A06484 seeks to amend the New York insurance law concerning the copayment and coinsurance amounts charged by insurers for physical and occupational therapy services. The central tenet of the bill is that the copayment or coinsurance for services rendered by licensed physical or occupational therapists cannot exceed 25% more than what is charged for an office visit to a licensed primary care physician or osteopath under similar circumstances. This provision aims to make physical and occupational therapy more affordable for patients, promoting better access to necessary treatment that may be vital for recovery and health management.

Contention

While the bill has gained support from various stakeholders advocating for patient rights and affordable healthcare, it is not without contention. Critics have raised concerns regarding the potential financial impact on insurance companies and providers. Some argue that limiting the copayment structure might result in insurers adjusting their coverage models or raising premiums in other areas. Furthermore, there are considerations regarding appropriate utilization reviews and how the reimbursement process may be affected by such legislative changes. Thus, the bill has sparked discussions about balancing patient access to care with the financial sustainability of insurance practices.